Family

I've a gentleman with dementia. Properly, he's got ICD-10 F00.12 Alzheimer's disease, late onset, severe.

He couldn't manage at home, had support, progressed, had respite care and now is in permanent care within an EMI Residential Home.

He is happy.

Within the meaning of the Mental Capacity Act 2005, with regard to decisions on his placement and future care, he's an incapacitated adult.

I have seen him many times at this care home, he always has been settled, cared for and content. My nursing colleagues see him and find him equally well. An Occupational Therapist assessed him. A Physiotherapist has looked at his mobility of late, as it's deteriorated. A Dietician saw him 2 weeks ago to give advice on dietetic input. A Modern Matron from the PCT saw him recently to look at pressure care and prevention of sacral sores (which he's never had, but he's increasingly sedentary). His GP reviews him episodically to consider physical health concerns (episodic joint pain and cramps, mostly). An external Independent Mental Capacity Advocate (IMCA) reviewed care and felt it would be in his best interests to remain in that care home receiving the care he was receiving.

His mental health has been stable, he's on no medication at all and hasn't needed any.

The EMI Residential care home has had two unannounced visits from the regulatory body CSCI this year and found to be absolutely fine. With so many professionals going in, often unannounced when we're in the area, we've also found everything to be fine. Scrutiny of the care plans show care to be fine. No families or residents have complaints/issues.

So, my patient's in a good care home receiving good care that oodles of professionals over a many months consistently see to be the case.

The home feels they may have to serve notice on him. They do not want to, they feel great warmth for him and enjoy caring for him (which they do well). They're very patient centred, if he has sleep disruption (as he does) and wants a bath at 2.00am (as he did) then he has one. When he was offered food at meal times but declined then was hungry later on he ate pizza just before midnight. They're sensitive to his care and are very accomodating.

My patient has 2 daughters. One thinks he's getting great care. She told me today that every time she visits dad,"He's happy, and that's the most important thing." She thinks he's well cared for. She wants him to stay there.

Another daughter wants him moved. She has no formal mental illness diagnosed but in the couple years I've (endlessly) seen her I'd wager good coin she's got a personality disorder. Maybe this is kinder than her sister who says she's a "vile woman" who's been "thinking of herself all her life" and "is wicked."

This daughter concedes that all major care is delivered (he is fed, washed, toileted, mobilised and so on) but that the quality of care falls short of what she wants. So she harasses staff. Daily. And generates prolific pages of complaints. Endlessly.

Protection of Vulnerable Adults (POVA) was initiated but hasn't had helpful outcomes since the daughter's malign influence hasn't been sufficient to enable police or agencies to be involved. The POVA meeting recognised she lied and mislead people and misrepresented people's views.

My patient's happy. He's happy to stay there. The care home want him to stay there. The professionals feel he's best placed there. The independent IMCA feels he should stay there. One daughter wants him to stay there. The other daughter (who's the nearest relative) makes it untenable for the staff to look after him (and has moved him 3 times already).

The evidence base is that if he were to move at this stage in his illness he'll be dead within 12 months.

Is there any lawful way we can prevent the nearest relative from visiting her father when she's impacting so negatively on the home that her father's best interests are not being served?